At NCCN, our mission to improve the lives of patients with cancer is at the core of everything we do and ensuring patient safety is of utmost importance.

That's why we have launched the NCCN Just Bag It Campaign for the safe handling of vincristine, calling for health care professionals to always dilute vincristine in a 50ml mini-IV drip bag and never in a syringe.

Why Bag It?

Vincristine is an important chemotherapeutic agent used primarily in the treatment of patients with leukemia and lymphoma. When it enters the blood, it is highly effective at blocking the growth of cancer by preventing cells from separating. However, vincristine is a neurotoxin that causes peripheral neuropathy when given intravenously and which causes profound neurotoxicity if given into the spinal fluid, which flows around the spinal cord and brain.

Many patients who receive vincristine have a treatment regimen that includes other chemotherapy drugs that are administered intrathecally, or injected into the spinal fluid with a syringe. If vincristine is mistakenly administered into the spine, it is uniformly fatal, causing ascending paralysis, neurological defects, and eventually death.

To ensure that vincristine is always administered properly, NCCN’s Best Practices Committee, which is dedicated to improving cancer treatment protocols, has issued guidelines advising health care providers to always dilute vincristine in a mini IV-drip bag and never use a syringe. This precaution renders it impossible to accidentally administer the medication into the spine and greatly decreases the chances of improper dosage.

Vincristine Prepared in IV Drip Bag (RECOMMENDED)

Vincristine Prepared in Syringe (NOT RECOMMENDED)

Christopher’s Story

Christopher Robin Wibeto, the third of four children, a lover of movies, computer games and progressive rock music, passed away August 29, 2005 in Stanford, California at the age of 21 following a tragic medical error involving the mishandling of the chemotherapy agent, vincristine.

Christopher had been hospitalized for about a month with Non-Hodgkins Lymphoma, but was making progress as the treatments went on. He and his mother had discussed traveling to Florida and Georgia to visit his siblings when he felt better. He was also considering going back to school.

But one day, Christopher mistakenly received an injection of the chemotherapy agent vincristine into his spinal fluid. Widely used in patients with Leukemia or Lymphoma, vincristine should only be administered directly into a patient’s vein. When it enters the blood, it is highly effective at blocking the growth of cancer by preventing cells from separating. However, vincristine is a neurotoxin, and if delivered into the spinal fluid, causes paralysis and death, usually within days.

Medical oncologist Robert W. Carlson, MD cared for Christopher at another hospital following the mistake and watched, distraught, as Christopher’s condition deteriorated and nothing could be done to reverse it. He died within four days. When Dr. Carlson became CEO of the National Comprehensive Cancer Network (NCCN) in 2013, he vowed to take action to prevent future errors.

NCCN’s 27 member institutions create the cancer treatment guidelines that set the standard for care in the US and around the world. Dr. Carlson worked with NCCN’s Best Practices Committee to issue guidelines advising health care providers to always dilute and administer vincristine in a mini IV-drip bag and never use a syringe to administer the medication. This precaution renders it impossible to accidentally administer the medication into the spinal fluid and greatly decreases the chances of improper dosage.

Today, all NCCN member institutions have adopted the safety practice, and on November 10, 2016, Christopher’s parents, Robin and Debra Wibeto, joined NCCN to launch a national campaign: Just Bag It: The NCCN Campaign for Safe Vincristine Handling. The effort calls for all cancer treatment providers in the US and abroad to adopt the NCCN recommended guidelines to eliminate the possibility of this tragic medical error once and for all.

"We are proud and honored to be part of this campaign," Debra Wibeto said. "If it saves even one life, Christopher’s death will have made a difference."

Do you bag it?

Tweet us @NCCNNews with #NCCNJustBagIt and fill out the following form to report your participation

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Who bags it?

What to know about vincristine

For media

Who bags it?

To ensure that vincristine is always administered properly, NCCN’s Best Practices Committee, which is dedicated to improving cancer treatment protocols, has issued guidelines advising health care providers to always dilute vincristine in a mini IV-drip bag and never use a syringe. This precaution renders it impossible to accidentally administer the medication into the spine and greatly decreases the chances of improper dosage.

What you need to know about vincristine

Vincristine is an important chemotherapeutic agent properly administrated intravenously in the treatment of many patients with leukemia or lymphoma. However, improper administration of vincristine is fatal.

Vincristine should always be administered intravenously. When it enters the blood, it is highly effective at blocking the growth of cancer by preventing cells from separating. However, vincristine is a neurotoxin, so it should not be used in regions of the body with high concentrations of neurons, such as the spinal fluid, which flows around the spinal cord and brain.

Many patients who receive vincristine have a treatment regimen that includes other chemotherapy drugs that are administered intrathecally, or injected into the spinal fluid with a syringe. If vincristine is mistakenly administered into the spinal fluid, it is uniformly fatal, causing ascending paralysis, neurological defects, and death, usually within a week.

To avoid this error, health care providers should always dilute and administer vincristine in a mini IV-drip bag and never use a syringe to administer the medication.

This precaution renders it impossible to accidentally administer the medication into the spinal fluid and greatly decreases the chances of improper dosage.

Vincristine errors are relatively rare, but are unique in their level of mortality.

125 deaths have been reported in the U.S. and abroad since the inception of vincristine use in the 1960s.

Improvements in practice, including manufacturer- and pharmacist-issued warning labels, have reduced the number of deaths, but the error continues to occur.

The benefits of "bagging it" far outweigh the drawbacks.

Some health care providers may associate the use of an IV bag with a heightened risk of extravasation — or the leaking of a chemotherapy drug into the tissue surrounding the intravenous administration site — but research shows that the risk is extremely low (1

Although diluting and administering vincristine in a minibag may entail a change in practice for some providers, it is a simple procedure and the only surefire way to avoid this completely preventable error.

NCCN Templates

In 2008, the Best Practices Committee led the charge to publish the NCCN Chemotherapy Order Templates (NCCN Templates®). Today, there are more than 1,500 NCCN Templates®, which detail the most common regimens for many cancers and highlight safety parameters and special instructions.